Healthcare Provider Details

I. General information

NPI: 1750844528
Provider Name (Legal Business Name): JENNA LOUISE BURNS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 34TH ST
SAN DIEGO CA
92102-2416
US

IV. Provider business mailing address

4765 DAWES ST
SAN DIEGO CA
92109-2637
US

V. Phone/Fax

Practice location:
  • Phone: 619-232-2946
  • Fax:
Mailing address:
  • Phone: 443-994-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number15238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: